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III.Anderson: paranoid schizophrenia and civilly committed as mentally ill and dangerous to others; he physically attacked others A.Treatment with medication and therapeutic interventions. B.Periods of seclusion as part of a treatment plan because isolation reduces his fear of attacks from others and the risk of violence in delusional “self-defense.” C.Restraints are unnecessary in seclusion because Anderson does not engage in conduct that is directly self-injurious.

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IV.Baker resembles Anderson; diagnosed with paranoid schizophrenia following physical attacks against others. He attacks in response to hallucinatory orders from God. A.Baker resembles Anderson in that he is subject to civil commitment because he endangers others due to his serious mental illness. B.Baker receives medication and therapeutic interventions. C.Baker differs from Anderson in that his violence is a response to auditory hallucinations. D.In seclusion, the auditory hallucinations exacerbate.

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V.Cook resembles Anderson and Baker in the experience of delusions and hallucinations that trigger physical assaults against others. He also suffers from NMS that precludes the administration of medication. A.Treatment alternatives: interpersonal interaction; development of relationships with clinicians or staff; situational interventions; avoiding circumstances that trigger the hallucinations and delusions. B.Seclusion or restraints may be components in a treatment plan; these alternatives might be more or less intrusive or aversive for specific individuals.

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VI.Davis: chronic and serious depression since adolescence; ongoing psychotherapy and antidepressive medication; attempted suicide. A.Committed as mentally ill and dangerous to himself; He receives antidepressive medication and therapy. Attempted suicide twice during this commitment. B.Seclusion is not a viable option because he attempts to kill himself when alone. C.Sometimes placed in partial restraints so he can walk around the ward without engaging in self-injurious behavior. D.His delusional belief that his depression is punishment from God continues. E.He attempts suicide in response to hallucinations or without hallucinations in response to his hopeless despair.

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VII.East: seriously depressed; no psychotic distortion but constantly sad, pessimistic, and hopeless. He consumes a major overdoes of medication and leaves a note: “I’m sorry to disappoint everyone, but it just isn’t worth continuing to endure life.” A.Civilly committed as mentally ill and dangerous to himself. His request for release is denied. After the denial, he attempts suicide twice. B.Antidepressive medication and interpersonal therapy are continued, but they do not appear to significantly alleviate his depression. C.Seclusion is not a viable alternative due to his self- injurious conduct. D.Restraints reduce his ability to attempt suicide, but they exacerbate depression.

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VIII.Central Points A.Police power and parens patriae are distinct justifications for intervention. B.Justified intrusion under either requires reasoning that explains why this individual’s disorder justifies this specific intrusion. C.We intervene in the life of this specific individual with the specific form and severity of impairment that this individual suffers and the effects of that impairment on this person’s preferences, values, and fears. D.Thus, the question is always whether seclusion, restraint, medication, or any available alternative is defensible for this person in these circumstances.